Didactic: How to Conduct a Tele-Physical Exam Hack Session 4...Sep 01, 2020 · Didactic: How to Conduct a Tele-Physical Exam Tina Gustin, DNP, CNS, RN & Carolyn Rutledge, PhD, FNP-BC,

26Saving Lives. Protecting Americans.

Didactic: How to Conduct a Tele-Physical

Exam

Tina Gustin, DNP, CNS, RN & Carolyn Rutledge, PhD, FNP-BC,

Center for Telehealth Innovation, Education, & Research (C-TIER),

Old Dominion University, Norfolk, VA

Kathy Wibberly, PhD, Mid-Atlantic Telehealth Resource Center, Charlottesville, VA


Objectives

• Participants will:

Understand the process for conducting a telehealth visit

Be able to select the equipment needed to conduct a physical assessment through telehealth

Be able to collect physical data through a videoconferencing session without peripherals

Utilize creative strategies to obtain clinical data


Key Steps to a Successful Visit


Before Encounter

• Make sure protocols are developed and understood

• Practice and become comfortable with the Equipment

• Test the equipment to make sure there are no complications

• Prepare the patient for the visit.

• Be sure to have IT available if possible

• Make sure you have the consent for the visit if needed (remember each state’s guidelines are different)


Beginning of Encounter

• Purpose of Encounter – Why you are conducting the visit.

• Consent – Does patient agree with purpose and to participate? (chart)

• Identify those at Each Site – Who is with patient and is ok. May have patient and provider show identification.

• Discuss Security – Assure patient that their information will be secure.

• Outline Session – Let patient know what to expect.

• Equipment Expectations – Explain what to expect of equipment and what to do if connection is lost.


Conducting of Encounter

• Obtain History/Subjective – Maintain same standards of care as an in-person visit.

• Obtain Clinical Data

Use creative strategies

Use observational skills

Have patient and/or family assist in gathering data

Use devices/objects found in the home (i.e., flashlight)

• End encounter – Provide a plan, set up referral, send notes/texts.


Telehealth Etiquette


Environment

• Assure lighting is correctly placed

• Eliminate background noise

• Check surroundings

• Background


Environment

• Appearance

• Clothing

• Lab Coat/Name Badge

• Head Placement

• Eye Gaze


Communication

• Pacing

• Empathy

• Facial and Verbal Congruency

• Resting Face

• Listening


Security

• Privacy of Patient Site

• Privacy of Provider Site

• Equipment Security

• Consents


Obtaining Clinical Data

• Videoconferencing using creative strategies in place of peripherals

• Videoconferencing with peripherals

• Store and Forward

• Remote Patient Monitoring


Videoconferencing— No Peripherals

• When to Videoconference without peripherals

During crisis or pandemics (COVID-19) when can’t get peripherals to a patient

When clinical data is not relevant

o Mental Health Visit

o Educational Visits

o Some Patient Follow-up Sessions (i.e., reviewing tests, labs)


Exam Without Peripherals

• Requirements:

Household Items

Ability to carry out instructions

Someone to assist with exam

Creativity by provider

Ability to position the camera


Examples

• ENT

iPhone & Computer Camera

• Abdominal

Jumping Up and Down

• Respiratory

Crossing Arms

• Cardiac

Checking Edema


Videoconferencing With Peripherals

• Purpose of peripherals

Allow for clinical assessment at a distance

Allow for diagnostic testing at a distance

Allow of clinical treatment at a distance


Exam With Peripherals

• Types of peripherals

Noninvasive

o Stethoscope, otoscope, ophthalmoscope, pulse oximetry, EKG, etc.

Invasive

o Cystoscopy, Colposcopy


Store and Forward Technology

• Why Store & Forward with Videoconferencing

Information to inform the care patient is receiving

Follow-up exams

Diagnostic/Treatment Plan

o X-ray

o Cardiac monitoring

o Blood sugar


Practice Makes Perfect


ODU Resources

• Old Dominion University (ODU) Telehealth Physical Exam Playlist https://www.youtube.com/playlist?list=PLM0VF0yZsE6eRiWVQ-RwnkIqruaFzDAON

• Old Dominion University (ODU) Telehealth Etiquette Playlist https://www.youtube.com/results?search_query=old+dominion+telehealth+etiquette+playlist

https://www.youtube.com/playlist?list=PLM0VF0yZsE6eRiWVQ-RwnkIqruaFzDAONhttps://www.youtube.com/results?search_query=old+dominion+telehealth+etiquette+playlist


Here to Help!

https://www.telehealthresourcecenter.org/

https://www.telehealthresourcecenter.org/https://www.telehealthresourcecenter.org/https://www.telehealthresourcecenter.org/


MATRC

http://matrc.org/

http://matrc.org/


COVID-19 and MATRC


Contact

For More Information:

www.facebook.com/MATRC

www.MATRC.org


Your Telemedicine Questions,

Answered

Please submit your questions through the Q&A box

Documents

Didactic: How to Conduct a Tele-Physical Exam Hack Session 4...Sep 01, 2020 · Didactic: How to Conduct a Tele-Physical Exam Tina Gustin, DNP, CNS, RN & Carolyn Rutledge, PhD, FNP-BC,